ResMed S9 to A10 "upgrade" - Huge jump in AHI, CA, H, OA events - battling machine

[Dormeo]

I think the idea was that you would also raise the maximum IPAP. Last night the pressure line was plastered to the ceiling, apparently by snores and flow limitations. I would defer to the experts, but you might want to try opening up the max IPAP.

[SleeplessInPHX]

Well it seems that raising the maximum just means that the machine is going to blast to that number. Set at 18 we see the same thing: the machine just hits the ceiling and stays there.

I can't do 18. That's an impossible pressure. My chest feels like a balloon and I got under two hours "sleep" in before I just shut it down and gave up. 


   

[geauxdbl]

What if you keep EPAP fixed around 8 or 9, where it was at first and was more comfortable, and raise Pressure Support to increase IPAP instead? Remember, on a VAuto, the difference between EPAP and IPAP is fixed and not independent. If it detects flow limit/snore/OA events, it's going to raise your EPAP, and your IPAP will be a fixed number above that. That number is your Pressure Support value. It's the increased EPAP that I find uncomfortable, and the VAuto's strength is its ability to get the difference between EPAP and IPAP more than 3cm apart.

It also looks to me like that cluster of events at the beginning of the night happened at sleep transition, thus setting your pressure higher than it should have been to start the night

[SleeplessInPHX]

A month since my last post and things are settling in. 

AHI - 1.42
Min EPAP - 8.0
Max IPAP - 15.0
PS - 4.0
Ti Min and Max to my liking

The only thing that I am trying to resolve right now is frequent arousal around 5:00am, then a hard time getting back to sleep. While the chart below states 9h 10m, there was little actual sleep after 5:00am. I'm trying to get a solid 8-hour+ block of sleep, uninterrupted. I've been trying ear plugs to see if I am waking from outside disturbances, so far they have not made any difference.

[Osiris357]

It looks like you need more pressure support and/or a soft cervical collar. Your events aren’t bunched but neither were mine and a soft cervical collar worked wonders on my flow limitations. They appear to be your main issue. A pressure support of 5 maybe 6 and a collar. 

Unless of course you feel fine. In that case don’t change anything. The experts will have a clearer vision of what’ll work for you.

[Dormeo]

It's good to hear that things are settling in. My advice is that you get up when you suspect you will not be able to sleep any longer. Little by little, you may then see the time at which wakefulness set in move later and later. Lying in bed awake for more than 20 minutes is contrary to sleep "hygiene" recommendations.

[Sleeprider]

I didn't expect the results you got from the increase in EPAP.  I think based on what we're seeing here Vauto mode min EPAP 8 max pressure 18, PS 5.  We don't know what is driving the flow limitation and snores, but they are impressive and long-lasting.  This looks a great deal like positional apnea.

No change since my last post. Good to see the AHI is apparently reduced and you are sleeping better.

[SleeplessInPHX]

Thanks for the quick responses everyone!

@Osiris357 - I'm good with the cervical collar, I've been using one for a few months. I'll add that to my "settings" when I post next time.

@Dormeo - The problem is, that would be 5:00am. If I can get light sleep for another 2+ hours, I'll stay in bed. I tried getting up when I first woke for a week a few weeks ago. The result was that I was tired at 7:00pm and all I could think about was going to bed early.

@Sleeprider - I'll bump up the Pressure Support in a few days.